Gastric carcinoma detected by cervical cytology.

This paper is a report on a case of gastric carcinoma of diffuse type in a young female patient aged 38. The patient was still asymptomatic at hospital admission, her only pathological sign being the finding of malignant cells of indeterminate origin at a routine Pap-test examination. Subsequent investigations showed the presence of a poorly differentiated gastric carcinoma, with metastatic diffusion to uterus, ovaries and peritoneum. Only a few cases of gastric carcinomas without cervical localization, detected by Pap-test, are reported in literature. A few other cases with cervical localization have been described. The aim of this work is to point out that a Pap-test smear may reveal the presence of extragenital tumors still unappreciated.

[Listeria monocytogenes meningitis. Description of a clinically significant case]. / Meningite da listeria monocytogenes. Descrizione di un caso clinico significativo.

Meningitis caused by Listeria monocytogenes is a rare affection: it develops from close contagion as professional illness (veterinarians, butchers) or in newborns by infected mothers; in indirect way for ingestion of contaminated food in subjects at high risk: elderly, immunosuppressed patients, alcoholics, diabetics. Clinically it is not diversified from the other bacterial meningitises. In this paper we present a case of Listeria monocytogenes meningitis in an adult female, without a sure occasion of infection and in absence of the factors of typical risk.

Primary lymphoma of the liver - a case-report and a review of the literature.

A case of primary lymphoma of the liver in a 72-year-old man is reported. The patient showed a three to four month history of abdominal ache, low grade fever, and weight loss. The presence of a large mass occupying the V and VT hepatic segments was demonstrated; no other organs were involved and no evidence of lymphoadenopathy was found. Laboratory tests showed a remarkable increase in ESR, LDH and alkaline phosphatase while CEA and alpha-1 fetoprotein were within the normal values. Two ultrasound-guided needle biopsies on the hepatic lesion did not produce any significant tissue for diagnosis. Therefore the V and VI hepatic segments were excised; a hard, greyish mass with the largest diameter of 6.5 cm, was found at laparatomy. Histology of the surgical specimen showed the presence of a malignant non-Hodgking's B-cell lymphoma, centroblastic-centrocytic, diffuse type (working formulation: G) of intermediate grade of malignancy. Staging was completed with lymphography, and bone marrow biopsy; both proved normal. After the operation adjuvant chemotherapy was commenced (COP for six cycles). Follow-up has so far shown no signs of recurrence after 24 months. In conclusion, the diagnosis of primary lymphoma of the liver is very difficult and is often reached only after histologic evaluation of the surgical specimen. Moreover, this disease has a much more favourable prognosis than the hepatocellular carcinoma and other primary or secondary liver cancers; therefore accurate investigations are important to reach the correct diagnosis.

[Obesity and insulin resistance]. / Obesità e insulinoresistenza.

Obesity is a problem of increasing epidemiological importance in industrialized western countries, that is linked with several metabolic disorders, especially of glucose metabolism. We have evaluated the insulin resistance and the existence of relation with overweight and markers of lipidic metabolism; for this purpose body mass index (BMI), plasma glucose and insulin at fasting (G-O' and IRI-O' respectively) have been measured together with fasting cholesterol (C), C-HDL, C-LDL and triglycerides (TG) in 27 obese female outpatients and in 18 normal age-matched women. Diabetic subjects had been previously excluded from the study. AUC-G, IRI-120' and AUC-IRI were significantly higher in obese women than in controls, C-HDL was lower, while the other lipidic parameters were similar in the two groups. BMI and IRI-O' were inversely related with C-HDL and directly with C-LDL; BMI was also directly related with IRI-O' and netAUC-IRI. In conclusion obesity causes not only glycemic impairment, but also atherogenic alterations of plasma lipidic parameters "per se" and/or through insulin-resistance; therefore it must be considered a pathologic condition or, at least, a risk factor of cardio-vascular diseases and treated with the greatest care.

[Dyslipidemia in obesity: pathogenetic considerations and our experience]. / Dislipidemia nell'obesità: considerazioni patogenetiche e nostra esperienza.

The prevalence of obesity is increasing today in western industrialized countries: therefore, many authors are focusing their attention on its multiple endocrine and metabolic effects. Because of the pathogenetic linkage between obesity and dyslipidemia, we have studied serum lipid pattern in a group of obese women: HDL-Cholesterol (HDL-C) deficiency was the most striking lipoproteinemic disorder. This fact points out, in our opinion, that obesity must be considered as a risk factor for cardiovascular disease.

[Asymptomatic bilateral occipital calcifications. A possible atypical form of Sturge-Weber-Krabbe syndrome?]. / Calcificazioni occipitali bilaterali asintomatiche. Una possibile forma atipica di sindrome di Sturge-Weber-Krabbe?

Sturge-Weber-Krabbe syndrome is a rare congenital neuro-cutaneous disease which is characterized, in its full clinical expression, by facial naevus flammeus and epilepsy with mental retardation. Different atypical cases in which one or more symptoms are missing and clinical course is benign, have been reported in the literature in recent years. In the present paper a possible case of this syndrome radiologically diagnosed, without neurological and cutaneous symptoms, is reported; the importance of a more comprehensive study of this complex disorder, with particular attention to the incomplete forms, is stressed.

[Association of hyperthyroidism and diabetes mellitus. Description of a case with partial recovery of pancreatic beta-islet function]. / Associazione di ipertiroidismo e diabete mellito. Descrizione di un caso con parziale ripristino della funzione pancreatica beta-insulare.

The coexistence of Graves' disease and insulin-dependent diabetes mellitus is well known among autoimmune polyglandular syndromes and sustained by common underlying immune pathogenic factors. Hyperthyroidism itself may lead to impaired glucose tolerance in subjects with intact beta-cell function through various not well clarified mechanisms and treatment of thyroid hyperfunction, on the other side, generally ameliorates the degree of metabolic control when diabetes is pre- and/or coexisting. We report a case of Graves' disease associated with diabetes mellitus, in which a partial recovery of insulin secretion is documented after euthyroidism was restored.

[Osteocalcin and hyperthyroidism]. / Osteocalcina e ipertiroidismo.

Osteoporosis may be induced by hyperthyroidism through an increase of bone turnover, because bone resorption exceeds formation in this condition. Also therapy with 1-thyroxine, especially by TSH-suppressive doses, may induce a reduction in bone mineral content. Circulating osteocalcin (sBGP) significantly increases both in endogenous and exogenous hyperthyroxinemia and is considered a reliable non invasive marker of bone turnover. In this study an extra-increase of sBGP in hyperthyroid post-menopausal women towards pre-menopausal is reported, the persistence of high sBGP levels in patients affected by any type of hyperthyroidism after four months of therapy and a positive relationship with thyroid hormones (fT4). Therefore monitoring of this serum marker may be suggested also in patient chronically treated with 1-thyroxine to avoid, if possible, overzealous therapy.

[Prognostic significance of hypereosinophilia in surgically treated breast carcinoma. Our experience]. / Significato prognostico della ipereosinofilia nel carcinoma mammario operato. Nostra esperienza.

Several Authors have published that hypereosinophilia is often related to solid carcinoma and mostly to mucin secreting epithelium carcinoma. Such hypereosinophilia has been considered a negative prognostic symptom. In this trial we have studied our out-patients affected by breast cancer who showed hypereosinophilia during their post-surgical follow-up or therapy. Such hypereosinophilia was not related to any symptom of progression of neoplasia. We thus suppose that hypereosinophilia associated with breast cancer is probably not related to the development of neoplastic tissue.

[Carcinoembryonic antigen (CEA) and mucinous-like tumor associated antigen (MAC). Statistic correlation in advanced breast carcinoma]. / Antigene carcinoembrionario (CEA) e antigene tumore associato mucino-simile (MCA). Correlazione statistica nel carcinoma mammario in fase avanzata.

In this study we have determined the plasmatic values of carcinoembryonic antigen (CEA) and mucinous like tumor associated antigen (MCA) in 20 women with metastatic breast cancer. CEA and MCA were determined by enzyme immunoassay technique. The results were analyzed by test r for the statement of statistical correlation. Since r was inferior to p 5% (r = 0.3255; p = 0.4438) the 2 parameters are not correlated and their biological expression must be considered independent.

[Systemic adjuvant chemotherapy of bladder carcinoma with 5 fluorouracil and cyclophosphamide]. / Chemioterapia adiuvante sistemica del carcinoma vescicale con 5 fluorouracile e ciclofosfamide.

Patients with bladder cancer in pT2 and pT3 infiltrating stages have a 5 year survival rate less than 50% after primary surgical and/or radiant therapy. Aim of the present study was to evaluate if adjuvant chemotherapy could improve survival in these subjects. For this purpose, 16 patients underwent treatment with 5-Fluorouracil and cyclophosphamide (min. three, max six courses). The obtained results have shown a 5 year actuarial survival rate of about 48%. Our experience has not shown therefore any improvement compared with primary treatment alone.

[Adrenal incidentaloma in a patient operated upon for colon carcinoma]. / Incidentaloma surrenalico in paziente operato per carcinoma del colon.

The extensive use of visualization techniques has allowed the finding of adrenal masses without clinical symptoms in a growing number of patients affected by diseases of different nature. The challenge of these masses, so called incidentalomas, is particularly diagnostic but also prognostic and therapeutic. A flow-chart of proper investigations utilized in a tumoral patient harbouring a left adrenal mass, permitted the correct diagnosis and prognosis.

[Thyrotoxic periodic paralysis and Graves' disease. Description of an HLA-CW7-positive case]. / Paralisi periodica tireotossica e morbo di Graves. Descrizione di un caso HLA-CW7 positivo.

Thyrotoxic periodic paralysis is an uncommon complication of hyperthyroidism, more frequent in Oriental populations and in male than in female subjects. Electron microscopic investigations have shown characteristic degenerative changes of muscle fiber. In this study the sequence of pathophysiologic events proposed by the literature is illustrated and a case of thyrotoxic periodic paralysis in a HLA-CW7 positive patient affected by Graves' disease is reported.

[Platelet aggregation during adjuvant chemotherapy with CMF]. / L'aggregazione piastrinica in corso di chemioterapia precauzionale con "CMF".

We have studied platelet aggregation in fourteen pre- and post-menopausal women treated with cyclic adjuvant CMF chemotherapy for mammary cancer with positive axillary nodes, previously operated. Aim of the investigation is to evaluate the effect of chemotherapy on platelet aggregation. The obtained results demonstrate that CMF therapy does not modify platelet aggregation in both pre- and post-menopausal patients.

[The ototoxicity of cisplatin in the chemotherapy of tumors of the head-neck area. Our experience]. / Ototossicità del cisplatino nella chemioterapia dei tumori del distretto testa-collo. Nostra esperienza.

The literature reports conflicting results on ototoxicity, one of the best known adverse effects of cis-platinum. An audiometric study was therefore performed in patients treated with this drug for tumours of the head and neck. The possible hearing loss does not rule out the use of cis-platinum in our experience.

[Primary amyloidosis. A case report]. / Amiloidosi primitiva. Descrizione di un caso.

Primary amyloidosis is an uncommon disease which can be considered a diagnostic challenge. A recently observed case, initially characterized by peripheral neuropathy and subsequently by heart failure and sudden death, is described.

[Chronic lymphatic leukemia with cerebral localization. A case report]. / Leucemia linfatica cronica con localizzazione cerebrale. Descrizione de un caso.

Central nervous system (C.N.S.) involvement is present in 20% of leukemic patients, while it accounts for only 2% of primary extranodal localizations of malignant lymphoma (M.L.). A clinical case in which a neurological syndrome is the opening symptom of chronic lymphatic leukemia (C.L.L.) is described.